Chains step into HIV/AIDS prevention

By Alaric DeArment

Stopping a viral pandemic of any kind presents a major challenge that historically has often taken decades or even centuries, as occurred in the cases of polio and smallpox. But stopping or even slowing a pandemic is made all the more difficult when people who carry the virus face stigma and ignorance from their families, communities and governments.

This has been the case with HIV and AIDS, and has been a major barrier to prevention efforts, including promoting safe-sex practices and getting people tested. The problem is serious enough that United Nations’ secretary-general Ban Ki-moon called stigma the single most important barrier to public action. But a new pilot program announced last month hopes to reduce stigma by bringing HIV testing to the retail pharmacy.

Walgreens is partnering with health authorities and service organizations to provide pharmacist-administered testing for the virus that causes AIDS, the retail pharmacy chain said.

The company is participating in a Centers for Disease Control and Prevention pilot with Greater Than AIDS and other organizations and local officials to expand HIV testing services and connect more people with the virus to treatment and care.

Working with Greater Than AIDS, health departments and local AIDS organizations, Walgreens provided free HIV testing at 47 stores in 20 cities to support last month’s National HIV Testing Day. About 1.1 million people in the United States are living with HIV, but nearly 1-in-5 don’t know they have it; and between 55,000 and 58,500 people become infected with the virus each year, according to the CDC.

Through the first phase of the two-year program, select Walgreens pharmacies in Chicago and Washington, D.C. — and a select Take Care Clinic in Lithonia, Ga. — are offering free HIV testing. The CDC plans to use pilot results from select pharmacies and in-store clinics in urban and rural areas identified as highly impacted by HIV to develop a model that pharmacists and nurse practitioners can use to implement HIV testing throughout the nation.

Retail pharmacies have been offering testing for diseases ranging from high cholesterol to cancer for years, but offering HIV testing presents a whole new realm of possibilities and challenges.

HIV testing traditionally has taken place at physicians’ offices and community health centers, but offering it at the pharmacy — not to mention a Food and Drug Administration panel’s recent endorsement of the over-the-counter approval of the over-the-counter OraQuick in-home HIV test — expands the range of services people can get with a simple walk to the neighborhood store.

At the same time, while any chronic disease tends to be a private and emotionally charged issue, HIV is especially so, considering the long history of stigmatization of people with the virus due in part to its frequent association with intravenous drug users; lesbian, gay, bisexual and transgender people; and sex workers.

According to a CDC article published in 2006, medical systems’ treatment of HIV as an “exceptional” disease has helped to feed stigma, resulting in infected people often not getting tested until they’re already sick. That year, the CDC released revised recommendations to regard HIV/AIDS as a treatable disease, and one of the goals of the Walgreens-CDC pilot program is to reduce the stigma associated with the virus. Perhaps making HIV testing something people can do at the same place they buy cold medications, magazines and toothpaste rather than at a clinic can help make it seem more routine.

But if routine HIV testing is to become a common feature at retail pharmacies, there are some other considerations as well. In addition to anonymity, it’s important to provide services like prevention counseling and referrals, as well as counseling and emotional support for patients who test positive. Stigmatized or not, HIV remains a life-threatening and life-changing disease. According to the CDC article, while 70% of people tested at publicly funded sites received their results and test information, fewer received counseling or referrals, and the figures were even lower for people tested in private settings. The FDA Blood Products Advisory Committee also expressed concern about lack of access to counseling when recommending OTC approval of the OraQuick test.